Annual report for fiscal year ...

STATE CENTER
FOR HEALTH STATISTICS
ANNUAL REPORT
FOR
FISCAL YEAR 2005
North Carolina
Department of Health and Human Services
Division of Public Health
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699- 1908
September 2005
State of North Carolina
Michael F. Easley, Governor
Department of Health and Human Services
Carmen Hooker Odom, Secretary
Division of Public Health
Leah Devlin, D. D. S., M. P. H., State Health Director
State Center for Health Statistics
Gustavo Fernandez, Ph. D., Director
1908 Mail Service Center
Raleigh, NC 27699- 1908
( 919) 733- 4728
www. schs. state. nc. us/ SCHS
September 2005
The Department of Health and Human Services does not discriminate on the basis of race, color, national origin,
sex, religion, age or disability in employment or the provision of services.
350 copies of this public document were printed at a total cost of $ 1,295.03 or $ 3.70 per copy. 8/ 05
Table of Contents
Section I. Introduction ................................................................................................................. 1
Foreword....................................................................................................................... ......... 1
Vision Statement ..................................................................................................................... 1
Statutory Authority ................................................................................................................. 1
History ............................................................................................................................... .... 1
Section II. Developments in SCHS During Fiscal Year 2005 .................................................... 2
Background ............................................................................................................................. 2
Organization of SCHS ............................................................................................................ 2
Changes During Fiscal Year 2005 .......................................................................................... 2
Section III. SCHS Units ............................................................................................................... 7
Operations, Quality Control, and Administration Unit .................................................... 7
Description.................................................................................................................... . 7
Services ........................................................................................................................... 7
Accomplishments in FY 2004- 2005 ............................................................................... 7
Proposed Initiatives for FY 2005- 2006 .......................................................................... 9
N. C. Birth Defects Monitoring Program .......................................................................... 11
Description.................................................................................................................... 11
Services ......................................................................................................................... 11
Accomplishments in FY 2004- 2005 ............................................................................. 11
Proposed Initiatives for FY 2005- 2006 ........................................................................ 12
Central Cancer Registry .................................................................................................... 13
Description.................................................................................................................... 13
Services ......................................................................................................................... 13
Accomplishments in FY 2004- 2005 ............................................................................. 13
Proposed Initiatives in FY 2005- 2006 .......................................................................... 15
Health and Spatial Analysis Unit ...................................................................................... 16
Description.................................................................................................................... 16
Services ......................................................................................................................... 16
Accomplishments in FY 2004- 2005 ............................................................................. 16
Proposed Initiatives for FY 2005- 2006 ........................................................................ 17
Statistical Services Unit ...................................................................................................... 18
Description.................................................................................................................... 18
Services ......................................................................................................................... 18
Accomplishments in FY 2004- 2005 ............................................................................. 19
Proposed Initiatives for FY 2005- 2006 ........................................................................ 19
Section IV. Summary .................................................................................................................. 20
Fiscal Year 2005 Annual Report
State Center for Health Statistics i
SCHS FISCAL YEAR 2005 ANNUAL REPORT
Section I. Introduction
Foreword
The SCHS Fiscal Year 2005 Annual Report describes the work done in the State Center for
Health Statistics ( SCHS) during this past year and summarizes current and planned activities.
The report also presents the challenges that are expected to confront SCHS during the upcoming
fiscal year. SCHS operates in the Chronic Disease and Injury Section in the Division of Public
Health within the North Carolina Department of Health and Human Services.
Vision Statement
The State Center for Health Statistics, by providing high- quality information on the health of
North Carolinians, will positively influence decision- making and health policy, thereby
improving the health of all our citizens. By making better use of our human and technical
resources, we strive to provide health data to policy makers, researchers, and citizens as
efficiently and quickly as possible. Internally, the State Center seeks to create a better work
environment, resulting in both successful employees and satisfied customers.
Statutory Authority
The State Center is authorized by North Carolina General Statute under § § 130A- 371 to 130A-
376 to collect, maintain, and analyze health and health- related data and to explore new or
improved methods for obtaining data. The Center is also charged with managing the state’s
Central Cancer Registry ( CCR) as established by General Statute under § § 130A- 205 to 130A-
215, and the Birth Defects Monitoring Program ( BDMP) as established by General Statute under
§ § 130A- 131.16 to 130A- 131.24.
History
Created as the North Carolina Bureau of Vital Statistics by the State Legislature in 1913, the
Bureau evolved by 1980 into the State Center for Health Statistics. In 1980, Governor James B.
Hunt, Jr. directed the state health agencies ( then known as the Division of Health Services) to
administer the statistical activities mandated by the 1978 Public Law 95- 623. Under this Act, the
Division, through the State Center, was to coordinate all health data activity in the state and to
explore new ways of obtaining, analyzing, and disseminating health data. Since 1998, the State
Center has been part of the Division of Public Health in the N. C. Department of Health and
Human Services.
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State Center for Health Statistics Page 1
Section II. Developments in SCHS During Fiscal Year 2005
Background
Prior to FY 2005, SCHS contained two additional units: Vital Records and Health Informatics.
Vital Records has now become a separate section. Health Informatics staff were assigned to three
separate agencies in DHHS, depending on their function and duties. Some were assigned to the
new Vital Records Section, others transferred to the Administrative Support Section, and some
were assigned to the newly created Office of Public Health Preparedness and Response in the
Epidemiology Section. Since March 2002, SCHS has operated under its new structure, which has
helped focus its mission of collecting, analyzing, and disseminating public health information.
On June 6, 2005, SCHS was organizationally moved from the Legal and Regulatory Affairs
Section into the Chronic Disease and Injury Section.
Organization of SCHS
The State Center is presently comprised of four programmatic units and one administrative unit.
• Birth Defects Monitoring Program ( BDMP)
• Central Cancer Registry ( CCR)
• Health and Spatial Analysis Unit ( HSAU)
• Statistical Services Unit ( SSU)
• Operations, Quality Control, and Administration Unit ( OPS)
Descriptions of these units are given in Section III.
Changes During Fiscal Year 2005
Budget and Personnel: As with many other state agencies, SCHS suffered a budget cut of
$ 10,000 from state appropriations during FY 2005. This was in addition to previous cuts during
the preceding two years. SCHS managed to continue operations without loss of positions but had
to curtail some operations funded from state appropriations. In order to manage these cuts and
maintain core functions, SCHS has continued to maximize the use of Federal Financial
Participation ( FFP) funds, grants, contracts, and receipts from the National Center for Health
Statistics ( NCHS) administered through the Vital Statistics Cooperative Program ( VSCP). The
State Center has also continued to enhance some categorical services such as the Central Cancer
Registry and Birth Defects Monitoring.
Notwithstanding the cuts, the SCHS experienced modest growth during FY 2005 by creating two
new positions funded through Centers for Disease Control and Prevention ( CDC) grants to
enhance work in the Central Cancer Registry ( CCR). At this time, these positions are being
classified and posted for recruitment, expected to be completed during FY 2006. The Birth
Defects Monitoring Program Unit ( BDMP), although not adding any new positions, expanded its
surveillance coverage to include all acute- care hospitals providing labor and delivery and/ or
pediatric services in North Carolina. In addition, through the Center for Birth Defects Research
and Prevention Project, the BDMP increased its collaboration with the University of North
Carolina at Chapel Hill ( UNC- CH) for research into the causes of birth defects.
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State Center for Health Statistics Page 3
The State Center has at present 65 full- time equivalent positions ( FTEs). These positions are:
1 director
5 managers
5 administrative support staff
25 field staff or quality control staff
25 statisticians
4 applications programmers, computing consultants, or GIS specialists
Web Development: SCHS increased considerably the amount of information on its Web site
during FY 2005 to more than 22,000 pages and documents, doubling the number from the end of
FY 2004. Increasingly, the Web site has become a primary source for external and internal data
users. At the same time, the State Center maintains a schedule of regular publications and an
active distribution of printed special reports throughout the year. All regular and special
publications are now accessible on the web at the SCHS web site: http:// www. schs. state. nc. us/
SCHS/.
The increased use of the SCHS Web site by the public and other users is reflected in the
increased number of requests for pages and documents related to health statistics. Excluding
robots ( automated programs that gather web- based information), the number of requests in FY
2001 was 157,392; and the next year it increased 36 percent to 214,377. The number increased
even more ( 56%) in FY 2003 to 334,549. In FY 2004, there were 446,415 hits, an increase of 33
percent. During FY 2005, the number of non- robotic hits went up to 655,152, a further 47 percent
increase. In four years, use of the SCHS Web has more than quadrupled, a dramatic increase.
Figure 1 below graphically describes the trend.
Figure 1
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Furthermore, SCHS has increased Web support to other public health agencies by managing Web
sites for the Early Intervention Branch and for the office implementing the Health Insurance
Portability and Accountability Act ( HIPAA) in North Carolina. The State Center also continued
to manage the Office of Minority Health and Health Disparities Web site, maintain the Web sites
of the Epidemiology and Vital Records sections, and host the N. C. Healthy Schools site. In
addition, SCHS provides support for accessibility and online publications for the Division and
the Department.
SCHS has embarked on a project to make its Web site more accessible and responsive to the
needs of users. During FY 2005, we completed converting death files information into a
queryable system that now permits users to enter specific parameters for key variables and get
results quickly on- line. This is a key improvement over the previous passive system that allowed
for more limited information retrieval. SCHS has already started a similar project for the birth
data, which is expected to be completed during FY 2006.
Services to Users and Public: The SCHS’s core mission is the dissemination of health
information to administrators, policy makers, researchers, and the public at large. Although
information is distributed in printed form as well as on the Web, many of the services are
provided to people who call the SCHS main telephone line requesting health information.
Despite a reduction of the positions devoted to answering data requests, the SCHS has arranged
for this important function to be maintained with little decrease in timeliness or quality of
responses.
The simpler requests, requiring referencing an existing publication or the Web, can be answered
by support staff. However, most of the requests require more extensive search or programming.
These requests are submitted to the statisticians in the various units within SCHS. SCHS answers
the vast majority of these requests within a few hours or days at most. Only complex questions
requiring extensive SAS programming take longer than one week.
SCHS tracks the information services that it provides to others. Using that tracking system, we
know that there were at least 3,629 activities where health or demographic information was
provided to users from July 1, 2004 to June 30, 2005. This is an increase from last fiscal year of 3
percent and it reflects that, in spite of substantial improved access to information on the Web site,
many users continue to rely on staff to address their more complex data needs.
SCHS also handles many phone calls, related to programs or information, that are not recorded in
the activity reports. The number of phone calls handled during FY 2005 by SCHS over and
beyond those reflected in the activity reports was about 8,000.
Publications: SCHS produces a wide variety of publications. Many are part of the Center’s core
function of disseminating health information. Other publications are printed in collaboration with
other health agencies and focus on a particular issue of interest to that agency. SCHS also has a
system of special publications that reflect salient issues of public health interest. Occasionally,
SCHS will publish a Statistical Primer explaining a technical issue concerning statistics or
information processing. In addition, SCHS staff engage in extensive collaborations with
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State Center for Health Statistics Page 5
academicians and other health practitioners, sometimes resulting in joint authorship in a refereed
professional journal.
A title list of many of the publications done by SCHS can be found on the web site at:
http:// www. schs. state. nc. us/ SCHS/ pubs/ title. cfm.
During FY 2005, SCHS staff had sole or joint authorship on 8 journal publications and published
11 internal studies. Additionally, SCHS staff did over 50 presentations and posters during the
year; processed over 50,000 cancer records; investigated 30 cancer clusters in the state; and
conducted 4 special cancer projects. SCHS staff also reviewed over 9,000 records suspected of
having birth defects; engaged in 26 spatial analysis projects; and answered 14 special requests for
geographic analysis. SCHS published 19 special reports, ranging from data about health
disparities among America Indians and African Americans, to a comprehensive profile of health
status state- wide, and an updated booklet on cancer statistics.
Collaborative publications usually appear in the Web site under “ Journal Articles.” Many of these
collaborative publications are listed here under the individual units’ descriptions of activities
during FY 2005, found in Section III.
Collaborations: The four programmatic units in SCHS engage in extensive and varied
collaborations with agencies, ranging from those within the Division of Public Health to national
organizations and universities. Below are four examples of collaborations with other agencies
carried out by SCHS during FY 2005.
1. The Birth Defects Monitoring Program is in its third year as a collaborator, with the UNC
Department of Epidemiology, on the N. C. Center for Birth Defects Research and
Prevention. The Center’s goal is to identify the causes and means of preventing birth
defects. North Carolina is one of eight states being funded to participate in the CDC-funded
National Birth Defects Prevention Study, which is the largest ongoing case- control
study of birth defects in the world. Interviewing of cases and controls in North Carolina is
ongoing.
2. The Central Cancer Registry has been working with the Comprehensive Cancer Control
( CCC) program and the Advisory Committee for Cancer Coordination and Control to
evaluate the 2001- 2005 Cancer Control Plan and to develop the 2006- 2010 Cancer
Control Plan. The director of CCR attended national training with the CCC staff to best
utilize cancer registry data in planning and evaluation. The CCR has provided data for
both planning and evaluation, and the director serves on both the Care Subcommittee
workgroup and Steering Committee in development of the 2006- 2010 plan.
3. The Health and Spatial Analysis Unit continues to work closely with the HIV/ STD
Prevention and Care, Special Studies Unit on syphilis elimination. The North Carolina
Syphilis Elimination Project started in 1998. Since 1999, the Health and Spatial Analysis
Unit has created maps of new syphilis cases every quarter. These maps are used to
identify neighborhoods where rapid outbreak response, testing, counseling and health
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promotion might be needed. This targeted approach is leading to success – with a 71
percent decrease in early syphilis cases from 1998 through 2004 – and has led to further
collaboration on the spatial analysis of syphilis and HIV disease co- morbidity.
4. Staff of the Statistical Services Unit worked with the Division of Environmental Health
on a study of septic tank failure rates, comparing conventional ( gravel) systems with two
types of innovative septic tank systems. Staff of the Unit provided consultation to DEH
staff on the design of the sampling plan, sample size determination, data collection
instruments, and other study issues. The DEH is now in the process of collecting data in
the field. SSU staff will participate in the data analysis and interpretation phase after data
collection is completed.
A partial list of agencies with which SCHS collaborated on different projects during FY 2005 is
given below:
Women’s and Children Section, DPH
N. C. Chapters – March of Dimes
N. C. Child Fatality Task Force
UNC School of Public Health
Department of Maternal- Fetal Medicine, Wake Forest University School of Medicine
Division of Aging, DHHS
Division of Medical Assistance, DHHS
Office of Minority Health and Health Disparities, DHHS
Office of Research, Demonstrations, and Resource Development, DHHS
Epidemiology Section, DPH
Vital Records Section, DPH
Chronic Disease and Injury Section, DPH
Office of Healthy Carolinians, DPH
American Cancer Society
Indian Health Service
Local Health Departments
Cecil G. Sheps Center for Health Services Research
UNC Lineberger Cancer Center
Duke University Medical Center
Columbia University
UNC Carolina Mammography Registry
Battelle Center for Public Health Research and Evaluation
North Carolina Commission of Indian Affairs, Department of Administration
Breast and Cervical Cancer Control Program
Comprehensive Cancer Control Program
Division of Environmental Health, Department of Environment and Natural Resources
UNC School of Medicine, Center for Maternal and Infant Health
National Institute of Environmental Health Sciences ( NIEHS)
University of South Carolina Department of Ob/ Gyn- Genetics
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Section III. SCHS Units
Operations, Quality Control, and Administration Unit
Description
The Operations, Quality Control, and Administrative Unit is responsible for the day- to- day
management of fiscal, personnel, training, and facilities/ repair functions within SCHS. This Unit
facilitates the operations of the programmatic units while also ensuring that SCHS complies with
all DHHS and DPH policies and requests. The Unit has responsibility for tracking and
monitoring purchases and payments, contracts, grants, and assets.
Services
• Implements SCHS, section, division, departmental, state and federal policies, procedures
and strategic plans with respect to budget, purchasing and spending, personnel, contracts,
MOUs, grants, and safety.
• Develops and oversees all SCHS state, receipt, Medicaid reimbursement, and federal
award budgets and activities, including accounts receivable and payable and contract
expenditures, and provides budgetary analysis and data to SCHS, section, division and
departmental managers.
• Prepares and monitors paperwork and revisions for all personnel and salary actions, and
tracks and reports on SCHS employee training activities.
• Plans for SCHS space, furniture and equipment needs, and arranges for office space
rentals, requisitions of equipment, and furniture purchases.
• Ensures all new SCHS employees receive SCHS Welcome Packet, including SCHS
orientation, SCHS SOP guidebook, and starter supplies.
Accomplishments in FY 2004- 2005
• Received approval for reallocation of Printing Phototypesetter II to Administrative
Assistant I and to award a salary increase effective April 1, 2005.
• Received approval to grant an IRA for position 25070 effective April 1, 2005.
• Received approval to grant an IRA for position 25009 effective October 1, 2005.
• Approved training for Administrative Secretary II to receive Notary Public certification
on behalf of SCHS.
• Arranged for Microsoft Word and Excel training and began onsite payables and
purchasing training sessions for DPH purchasing/ payables clerk.
• Conducted onsite training sessions for new Vital Records administrative employee.
• Completed updated Adobe PageMaker and In Design Training for Publications
Coordinator and backup.
• To foster rapid responses to SCHS budget, purchase and payment needs, refined
standardized procedures for communicating with budget, purchasing/ payables clerk
previously relocated to division office.
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• Refined standardized procedures for keeping SCHS central files updated and purged
according to state records retention schedules and the SCHS Director’s guidelines.
• Established personnel file folder checklist to ensure completeness of all personnel records
and forms.
• Reconciled and completed SCHS Timesheet audits biannually.
• Implemented weather event drills and began revising SCHS Safety Manual.
• Completed third draft of SCHS SOPs and appointed new SOP project coordinator.
• Developed SCHS Non- Disclosure Agreement form and revised SCHS New Employee
checklist.
• Completed standardized formatting and cataloguing of SCHS internal forms.
• Began working with SCHS webmaster to ensure upload to the SCHS Intranet of finalized
SOPs.
• Completed revision of publications mailing list, including preparing and mailing 650
update letters to external customers. Tracked and compiled their responses.
• Completed ServList email address update with SCHS webmaster.
• Created, revised, edited, arranged for printing and mail out of:
– 3 SCHS annual publications ( Pocket Guide, Volume 1, and Volume 2)
– 5 SCHS Studies
– 2 Minority Health fact sheets
– 1 SCHS Annual Report for FY 2004
– 1 Statistical Brief
– Health Profile of N. C.: 2005 Update
– N. C.’ s Plan to Prevent Youth Suicide ( report for Injury and Violence Prevention)
– 6 WIC Brochures ( English and Spanish)
– Converted TB Manual to pdf for web page and inserted 24 forms in the Revised TB
Manual
– Revised 46 forms ( WCH, Vital Records, and State Lab)
– Created 4 new forms ( 3 WCH, 1 Vital Records)
– Coordinated printing requests for Cancer Facts and Figures, BRFSS envelopes, and
PRAMS supplies ( surveys, brochures, calendars, Spanish index cards, fact sheets,
envelopes).
– Provided quality control and tracking services to the SCHS Survey Team for monthly
mailing of 3,000 pre- survey letters.
• Completed and instituted SCHS New Hire Protocol and implemented Welcome Packet
for new employees
• Served on the DPH Nutrition and Food Committee related to the Six Forks Move Project.
• Participated in various internal SCHS committees, including Data Disclosure Committee
and Special Events Committee ( chair).
• Cotton Building Roof Reconstruction Project November 2004 to January 2005:
– Represented Cotton Building on Pre- Bid and Bid Committees and negotiated terms of
temporary relocations with DOA State Construction, PC Lab, Vital Records, and
Epidemiology Sections.
– Coordinated with DOA and Epidemiology the relocation of cars parking in rental
spaces in close proximity with Cotton Building to state parking deck for duration of
construction project.
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State Center for Health Statistics Page 9
– Coordinated with DPH IT and DPH Administrative Services Branch timetable and
logistics for temporary relocation of Cotton 2 personnel and their equipment.
– Implemented the temporary relocation of Cotton 2 personnel, including their
equipment and files to Cotton 1, Cooper 6 , Cooper 1 and Cooper 2 and their return to
Cotton 2.
• Began Cotton Building Beautification Project by completing repairs and painting to
Cotton 1 bathrooms ( including addition of new ceiling tiles, baseboards, and blinds),
foyer, and stairwell.
• Arranged for installation of snack machine for SCHS employees.
• Updated and reorganized SCHS mailroom, including selecting and installing new
accessories.
• Purchased, installed, and added caller I. D. function to new telephones for the CCR.
• Arranged for surplus of 296 items ( desktop computers, furniture, office equipment).
• Purchased approximately $ 140,000 in PCs ( 41), printers ( 8), servers ( 11), and software
( 13) for SCHS.
• For FY 2004- 2005, prepared and initiated authorized budgets for requirements and
revenue in approximately 18 cost centers in Fund 1160, totaling $ 4,751,440 including
$ 3,086,358 in salaries and fringes across multiple various revenue sources, including:
– $ 2,240,180 in state appropriations
– $ 590,690 in state receipts
– $ 133,801 in federal receipts
– $ 1,786,769 in federal grant or cooperative agreement awards
• Ensured that HIPAA and Workplace Harassment mandatory training completed by all
SCHS new staff and certification forms signed and turned in to DPH within specified
deadline.
• Ensured that all SCHS employees’ Work Plans contained provisions for:
– Mandatory training
– Customer service
– Activity report completion
– SCHS internal committee service
Proposed Initiatives for FY 2005- 2006
• Complete final draft of SCHS SOPs and upload to SCHS Intranet; keep updated.
• Begin pilot to ensure viability of SOPs.
• Publish main SOP directory, as well as a summary guidebook for all SCHS new
employees.
• Continue to refine SCHS New Employee Orientation Protocol.
• Get approval for reallocation of position 25052 to a classification more schematically
appropriate than its new Administrative Assistant I reallocation.
• Complete training of and transition work to division purchasing/ payables personnel.
• Maintain SCHS Central Files System and ensure adherence to the standardized
procedures for keeping files updated and purged according to state records retention
schedules and the SCHS Director’s guidelines.
• Organize and facilitate relocation of SCHS Survey Lab to new building.
• Complete Cotton Building repair and painting project.
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Page 10 State Center for Health Statistics
• Purchase new furniture for Cotton 1 and 2 bathrooms.
• Purchase, install, and add caller I. D. function to new telephones for SSU, BDMP, HSAU,
and Operations, as needed.
• Finalize CCR Unit personnel consolidation plan; coordinate and implement relocation of
personnel and equipment with other SCHS units.
• Request vendor quotations for new cubicles and new carpet for Cotton 2, and begin
paperwork to initiate purchases.
• Coordinate temporary relocation of SCHS personnel for possible staff relocation project
and coordinate purchase and installation of new cubicles and carpet at the same time.
• Ensure that all new employees complete HIPAA and Workplace Harassment mandatory
training, with certification forms signed and turned in to DPH within initial 90 days of
employment with SCHS.
• Ensure that all new SCHS employees’ Work Plans contain provisions for:
– Mandatory training
– Customer service
– Activity report completion
– SCHS internal committee service
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N. C. Birth Defects Monitoring Program
Description
The North Carolina Birth Defects Monitoring Program ( BDMP) was formally established by the
N. C. General Assembly in 1995. The BDMP ascertains data on infants who are born with serious
congenital anomalies diagnosed within the first year of life ( approximately 4,000- 5,000 infants
per year). Data are collected by trained field staff who systematically review and abstract hospital
medical records, supplemented by information from administrative health databases such as
hospital discharge data, vital records, and other sources. This intensive method of case
ascertainment provides the most complete, accurate, and timely data on the incidence of birth
defects, thereby enhancing its usefulness to public health programs. The program maintains a
central registry with patient identifying information which is considered confidential under state
law. The BDMP works closely with other sections in public health, including genetics and the
Child Service Coordination Program, as well as with university- based researchers, advocacy
groups, and other stakeholders. In addition, the BDMP carries out data analyses for the North
Carolina Child Fatality Prevention Task Force and maternal mortality surveillance, and provides
other statistical support to programs within the Children and Youth Branch, Women’s and
Children’s Health Section.
Services
• Respond to inquiries from health departments, physicians, legislators, and the public
concerning the occurrence of birth defects in their communities.
• Provide data needed to help design, target, and evaluate public health prevention
activities.
• Conduct descriptive epidemiologic studies of risk factors for birth defects in North
Carolina, and collaborate with universities and others on etiologic studies of birth defects
in order to identify new avenues of prevention.
• Improve delivery of services to children with special needs through identification and
referral to appropriate services.
Accomplishments in FY 2004- 2005
• The BDMP has been collaborating with the UNC School of Public Health on the N. C.
Center for Birth Defects Research and Prevention. Efforts over the past year have led to
improvements in the quality and timeliness of National Birth Defects Prevention Study
( NBDPS) clinical data, including streamlining the process of initial data collection and
clinical review.
• As an extension of the above project, the BDMP has submitted a request to CDC for
supplemental funding to study the cost and utilization of services among children with
craniofacial anomalies who are on Medicaid. Preliminary work on this project is currently
under way, with funding expected to begin in September 2005.
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Page 12 State Center for Health Statistics
• The BDMP has implemented a new clinical database for its central registry, and is in the
process of deploying the database in the field in order to implement a fully electronic data
system. This new electronic database, which will be fully in place by August 2005, is
improving the efficiency of data collection for the program. The new system will enhance
the timeliness of case ascertainment and facilitate identification and referral of children
and families for services.
• Working with the UNC Center for Maternal and Infant Health, the BDMP has developed
a system for tracking the birth outcomes for women who received maternal serum
screening at UNC Hospitals. This system will help researchers evaluate the performance
of the prenatal screening program, and to assess possible adverse pregnancy outcomes
that may be predicted using prenatal serum markers.
• The BDMP has initiated a data exchange agreement with the Virginia Department of
Health to improve ascertainment of North Carolina resident infants who are treated out of
state.
Proposed Initiatives for FY 2005- 2006
• Continue participating in the National Birth Defects Prevention Study.
• In conjunction with the UNC Department of Epidemiology and other collaborators,
contribute to the development of a long- term research agenda for the North Carolina
Center for Birth Defects Research and Prevention.
• Collaborate with NIEHS and the University of South Carolina Division of Genetics on
the multistate Anencephaly Genetic and Environmental Links ( ANGEL) Study.
• Collaborate with the National Birth Defects Prevention Network on upcoming multistate
research projects.
• Update BDMP web pages to provide more current and complete data on birth defects
occurrence, risk factors, prevention, and services.
Central Cancer Registry
Description
The Central Cancer Registry ( CCR) collects, processes, and analyzes data on all cancer cases
diagnosed among North Carolina residents. All health care providers are required by law to
report cases to the CCR ( as in nearly all other states), but the primary data source is hospitals.
The CCR supplements hospital data with reports from physicians who diagnose cases that are not
seen in a hospital. Death certificates and pathology laboratory reports are used to help identify
cases that are missed in the routine reporting. Duplicate reports are consolidated in the data
editing process. This is primarily a cancer surveillance activity – monitoring the incidence of
cancer among the various populations of the state.
Services
The data are used by:
• State and county health departments to target resources for health education and screening
services.
• Researchers for investigations into the causes and treatment of cancers.
• Public health advocates for focusing attention on the risk of cancer.
• The CCR staff to educate the public and provide evaluations of geographic and
behavioral risk. Summary data are published on the Internet and in several periodic
publications.
• National organizations ( CDC and NAACCR) that pool the data for national estimates of
cancer incidence. These data submissions are also used to evaluate the quality and
completeness of the CCR data.
Accomplishments in FY 2004- 2005
• The CCR was certified by the North American Association of Central Cancer Registries
( NAACCR) as a high- quality registry for the fifth consecutive year.
• Completed migration of all data on an Access- based system to an Internet- based data
management system. The Web- based system has allowed staff to run more ad hoc quality
reports, and to provide instantaneous feedback to facilities submitting data, and its “ Town
Square” feature facilitated communication among staff and with reporting facilities.
• Filled a number of critical positions with highly qualified staff, including a field staff,
three statisticians, an office assistant, and a director.
• In collaboration with the American Cancer Society, published 2004 Cancer Facts and
Figures both in hardcopy and on the Web site. Published 2005 County Cancer Profiles on
the Web site; it will be printed by the American Cancer Society in June 2005.
• Produced the Cancer Collection and Reporting Manual for use by all facilities required to
report to the CCR.
• Implemented reporting from three freestanding radiation centers ( one of 15 are
remaining), three large urology practices, one dermatology practice, and two out- of- state
pathology labs.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 13
• Conducted an annual basic registrar workshop in Asheville, which was attended by 27
registrars. This training is nationally recognized, and attended by registrars from other
states, and the training materials developed by CCR staff are used by the National Cancer
Registrars Association. This year’s course material included the FORDS, treatment,
coding, quality control, TNM 6th edition and data collection of non- malignant Central
Nervous System tumors. The CCR also conducted three training workshops on non-malignant
Central Nervous System tumors and three workshops for non- registrars on
implementation of Collaborative Staging.
• Participated in the second NPCR linkage with the Indian Health Service to identify
American Indians in the CCR database. Also completed manual linkage with tribal rosters
for two tribes that are not served by the Indian Health Service.
• Hired temporary employees through the National Program of Cancer Registries grant to
help with Death Clearance, doubling the speed and efficiency of the process for 2003
cases.
• The CCR is a member of the North American Association of Central Cancer Registries
( NAACCR), seven staff members belong to the National Cancer Registrar’s Association
( NCRA), and 10 staff members belong to the Association of North Carolina Cancer
Registrars ( ANCCR). The CCR has five staff members who serve on committees or
taskforces of NAACCR or NCRA and three staff members who served on the board of
ANCCR. Three staff members serve on subcommittees of the Advisory Committee for
Cancer Coordination and Control and one member serves on its Steering Committee. The
CCR has been actively involved in developing North Carolina’s new five- year cancer
control plan.
• Completed update to study of cancer around asphalt operations in the state. Several other
large- scale cluster investigations are ongoing and in various levels of completion,
including pediatric leukemia in Forsyth and surrounding counties, brain cancer in New
Hanover County, and lung cancer in Wilkes and surrounding counties. The CCR
responded to over 30 cluster inquiries this year, many of them requiring more than
cursory analyses.
• Historically, the Veterans’ Administration hospitals have not reported cancer incidence.
However, during 2004- 2005 the CCR received a large amount of data from them.
• Every year at the time of the NAACCR submission, a number of last- minute edits are
made to the data, on a snapshot of the database. This year, those changes were
implemented using a database with a data entry interface, enabling staff to make changes
quickly, store the changes made, and track that these changes were made to the main
database after the NAACCR submission.
Fiscal Year 2005 Annual Report
Page 14 State Center for Health Statistics
Proposed Initiatives in FY 2005- 2006
• Develop a system for efficiently processing pathology lab data, incorporating the newly
identified cases into the CCR’s main database.
• Develop a system for incorporating all paper records into the electronic data system.
• Enhance the Web- based data management system with the following: development of
simpler data entry screens for small facilities, a module for rapid case ascertainment staff
to enter reports directly into the CCR database, and automated record updating.
• Fill open positions, including a statistical supervisor, one statistician, and one field staff,
and complete the establishment of two CDC- funded quality control ( QC) positions.
• Establish a more efficient process for resolving county and address inaccuracies,
including linkage with the Division of Motor Vehicles.
• Add a geographic analysis component to our data analysis capabilities to facilitate our
response to requests for cancer cluster investigations.
• Enhance our research activities by having a staff person devoted full time to research.
• Work with the Commission on Cancer’s Liaison Program to initiate reporting by medical
oncologists. One of the QC staff will do a casefinding study on a large oncology practice
in the Triangle area.
• Work with hospitals and physicians to improve reporting to 98 percent complete.
• Work with the Veterans’ Administration hospitals to improve regular reporting.
• Collaborate with researchers and other outside data sources to improve the quality and
completeness of the CCR’s data through data linkages.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 15
Health and Spatial Analysis Unit
Description
The Health and Spatial Analysis Unit uses Geographic Information Systems ( GIS) and other
software to describe and analyze the spatial and temporal relationships that exist among
mortality, morbidity, births, and population characteristics, along with the environment in which
they occur.
The Health and Spatial Analysis Unit also develops and maintains the SCHS Web site. In
addition, the Unit supports other sections in the Division of Public Health with their Web sites,
the use of GIS and spatial analysis.
Services
• Responds to map requests from state and local public health agencies, organizations,
universities, and the public.
• Supports SCHS research, publications and presentations by providing maps and other
spatial analyses.
• Provides spatial analysis expertise to other state, local agencies and programs on long-term
projects. Collaborations include Epidemiology Section: HIV/ STD Prevention and
Control Branch, Special Studies Unit; Women’s and Children’s Health Section: Nutrition
Services Unit and Early Intervention Unit.
• Provides GIS technical support to other DHHS Divisions.
• Manages the SCHS Web site and provides support in website development for other DPH
sections, the Office of Minority Health and Health Disparities, and the interdepartmental
N. C. Health Schools Web site.
Accomplishments in FY 2004- 2005
• Continued work with HIV/ STD on Syphilis Elimination Project ( SEP).
• Continued geocoding of 2003 Vital Records.
• Developed North Carolina Health Data Query System.
• Developed an implementation plan for an address geodatabase.
• Updated time series maps on the Web site.
• Continued support of the Family Day Care Homes ( FDCH) Project.
• Updated and maintained information on SCHS Intranet.
• Maintained and provided to users a GIS database of licensed medical facilities.
• Provided layouts of poster presentations for all SCHS Units.
• Produced and presented posters at ESRI International GIS Conference and N. C. State
Conference.
• Presented spatial analysis project on syphilis and HIV Disease at the N. C. State GIS
Conference.
• Provided staff to serve as a member of the North American Association of Central
Cancer Registries ( NAACCR) GIS Workgroup.
Fiscal Year 2005 Annual Report
Page 16 State Center for Health Statistics
• Provided staff to serve on the State Government GIS Users Committee ( SGUC); one
staff person chairs the committee and all staff are members.
• Provided staff to serve as a member of the Geographic Information Coordinating Coun-cil
( GICC), by appointment from the Secretary.
• Provided staff to serve as chair of the SCHS Presentation Committee.
• Provided staff to serve as a member of the N. C. GIS Conference Planning Committee.
Proposed Initiatives for FY 2005- 2006
• Upgrade software for and update content of the online Health Atlas.
• Become a participating member of N. C. OneMap.
• Execute the implementation plan for the address geodatabase.
• Expand the North Carolina Health Data Query System for births and birth defects data.
• Test the streamline geocoding processes.
• Conduct additional spatial analysis of syphilis and HIV disease.
• Implement a state agency license scheme for ESRI GIS software.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 17
Statistical Services Unit
Description
The Statistical Services Unit collects, analyzes, and disseminates data on the health status and
health care use of North Carolinians. Staff also measure the effects that health services and
programs have on the citizens of North Carolina. The Statistical Services Unit consists of three
main work teams:
Survey Operations: Operates the Behavioral Risk Factor Surveillance System ( BRFSS) and
Pregnancy Risk Assessment Monitoring System ( PRAMS) for North Carolina, two CDC- spon-sored
health surveys. Provides survey and data analysis support to state and local public health
programs in North Carolina. Designs, tests, and conducts special public health surveys.
Vital Statistics: Produces the annual vital statistics and induced abortion files for data analysis
and reporting, provides data for the national Vital Statistics Cooperative Program, and works
with the Vital Records Section on data quality improvement efforts.
Health Services Analysis: Analyzes and disseminates data related to Medicaid, Health Choice,
and hospital discharges. Staff work closely with the Division of Medical Assistance and the
Office of Research, Demonstrations, and Rural Health Development on issues of mutual interest
to these programs and the Division of Public Health.
Services
• Answer thousands of requests a year from all segments of North Carolina’s population.
• Maintain and link together various data sets enabling the SCHS to do comprehensive data
analysis and health research.
• Publish a number of special research and evaluation studies and about six annual publica-tions.
• Present educational and training sessions to public health professionals, university stu-dents,
and other groups on data use, analysis, and interpretation.
• Provide extensive data analyses and reports for state and local public health agencies.
• Carry out special analyses of the Health Services Information System ( HSIS), Medicaid,
Health Choice, and hospital discharge data files.
• Produce an annual online County Data Book as part of the North Carolina Community
Health Assessment Process.
• Provide statistical and other support to the Office of the Chief Medical Examiner and
analyze the medical examiner data to meet the needs of North Carolina public health
programs.
Fiscal Year 2005 Annual Report
Page 18 State Center for Health Statistics
Accomplishments in FY 2004- 2005
• Produced five major annual publications and eight special reports in addition to the ones
listed below.
• Published two Minority Health Fact Sheets, one for American Indians and one for African
Americans, in cooperation with the Office of Minority Health and Health Disparities.
• Published the Health Profile of North Carolinians: 2005 Update.
• Published the 2003 North Carolina Health Statistics Pocket Guide.
• Published, on the State Center for Health Statistics Web site, data tables for live births
broken out by receipt of Medicaid, WIC, health department prenatal care, Maternity Care
Coordination, and Child Service Coordination.
• Published, on the State Center for Health Statistics Web site, extensive county- level
graphs showing time trends in key health indicators.
• Established the Child Health Assessment and Monitoring Program ( CHAMP), a state-wide,
representative household telephone survey that collects data on children’s health
issues.
• Produced the Local Public Health Department Expenditures report for the chief of the
Administrative Support and Community Liaison Section.
• Produced extensive data for the Health Carolinians 2010 Midcourse Review.
• Published, on the State Center for Health Statistics Web site, extensive data tables based
on the BRFSS and PRAMS surveys.
• Enhanced quality control activities in the Vital Statistics Unit to improve the accuracy of
the birth, death, and other vital data for North Carolinians.
Proposed Initiatives for FY 2005- 2006
• Continue to provide technical support to the State Infant Mortality Collaborative ( SIMC),
both for the North Carolina “ home team” and for the national group.
• Publish focused- care study on children with special health care needs, in cooperation with
the Quality Management Unit of the N. C. Division of Medical Assistance.
• Participate in the evaluation of expanded Medicaid coverage of family planning services
( family planning “ waiver”), in cooperation with the Sheps Center for Health Services
Research, the Women and Children’s Health Section, and the Division of Medical Assis-tance.
• Provide technical assistance to the Occupational and Environmental Epidemiology
Branch to implement a study of the impact of water quality on the health of swimmers in
Falls Lake.
• Complete publication on estimates of the number of medically fragile children in North
Carolina and their health care costs.
• Continue to work with the Carolina Population Center on the North Carolina Birth Out-comes
Project and publish a SCHS Studies report on the effect of neighborhood contex-tual
factors on preterm births.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 19
Section IV. Summary
During Fiscal Year 2005, SCHS moved to address changing needs in the area of health
information and dissemination. The old Geographic Analysis Unit ( GAU) was renamed Health
and Spatial Analysis Unit ( HSAU) to better reflect changes in its functions and to further
differentiate it from generic Information Technology functions. The differentiation was made to
clarify the roles of the unit as a result of a multi- year study carried out by the Department
examining all potential IT work within the Division of Public Health. Because the HSAU mainly
provides statistical and geographical analysis in support of health business functions, it is
important to maintain its identity as separate from traditional IT functions which are mainly
designated to provide technological support.
SCHS also continues to expand its research component in the areas of Birth Defects and Central
Cancer Registry. During FY 2005, a comprehensive and interactive database management system
was completed, allowing BDMP staff to dynamically enter field data from hospitals and have
access to the latest edited database. Both of those improvements permit quicker and more
accurate case abstracting work and should enrich the already expanded data base. This initiative
was part of the collaboration between the School of Public Health at UNC- Chapel Hill and the
BDMP at the SCHS and was made possible when UNC was awarded a CDC grant as a Center
for Excellence for Birth Defects Research in 2002, which facilitated investigations of birth
defects research questions. Cooperating with the N. C. State Laboratory of Public Health has also
expanded the available data from early screening tests that is used for the surveillance of newly
born infants with birth defects.
The Cancer Registry also saw the benefits of its Web- based case abstraction system which began
to bear fruit in increased accuracy and timeliness. This system, implemented in FY 2004, allows
field staff to enter data with greater accuracy and rapidity. CCR has also begun several
collaborative data- share agreements with investigators in several universities. Studies during FY
2006 should provide enhanced knowledge on key items of surveillance, prevention, early
detection, and treatment of cancer.
SCHS will continue to improve its Web site and postings, as that medium has become a central
piece in health data distribution and dissemination. SCHS has moved to increase health informa-tion
accessibility by posting all publications on its Web site and making the site easier to use.
Additionally, the SCHS initiated the creation of a queryable site that allows users much greater
flexibility in shaping inquiries into the death files. SCHS will continue to create dynamic data
systems on its Web sites during the coming year.
Once again, the SCHS experienced another significant growth in its BRFSS survey with in-creases
in the sample size and in the number of questions designed to address specific health
concerns from local and state agencies. Updated data from PRAMS was posted on the Web in a
more timely manner than in the past. Furthermore, a new survey designed to measure health risk
behaviors was started in January 2005. This system, called the Children’s Health Assessment
Monitoring Program ( CHAMP), promises to complement the information that the BRFSS al-ready
gathers for adults.
Fiscal Year 2005 Annual Report
Page 20 State Center for Health Statistics
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 21
During FY 2005, SCHS collaborated extensively with all sections of the Division of Public
Health, resulting in several publications. SCHS continued its policy of adjusting to reduced state
appropriations by increasingly relying on grants and receipts. This trend is likely to continue in
the foreseeable future. SCHS continues to answer thousands of inquiries each year from adminis-trators,
legislators, researchers, and citizens, and its accountability system for capturing work
activities has been improved.
The four programmatic units were productive during the year in addition to doing their mandated
and routine work; they also contributed to extensive data dissemination through regular and
special reports. The Operations, Quality Control, and Administration Unit, working closely with
the DPH Budget Office, was key in helping with the logistical complexities of having to relocate
all second floor staff to permit State Construction to put a new roof on the Cotton Building. This
dislocation of staff and work was effected as smoothly as possible thanks to the leadership of the
Operations, Quality Control, and Administration Unit and the flexibility of the staff who had to
be moved to alternative locations for several weeks. This Unit also continues to do an excellent
job in monitoring all components of operational support, including budget and personnel chal-lenges.
SCHS looks forward to engaging in future collaborations with health agencies, and will continue
to use its resources to serve the health information needs of the state in an efficient and effective
manner.
STATE OF NORTH CAROLINA
Department of Health and Human Services
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699- 1908
MEDIA RATE

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STATE CENTER
FOR HEALTH STATISTICS
ANNUAL REPORT
FOR
FISCAL YEAR 2005
North Carolina
Department of Health and Human Services
Division of Public Health
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699- 1908
September 2005
State of North Carolina
Michael F. Easley, Governor
Department of Health and Human Services
Carmen Hooker Odom, Secretary
Division of Public Health
Leah Devlin, D. D. S., M. P. H., State Health Director
State Center for Health Statistics
Gustavo Fernandez, Ph. D., Director
1908 Mail Service Center
Raleigh, NC 27699- 1908
( 919) 733- 4728
www. schs. state. nc. us/ SCHS
September 2005
The Department of Health and Human Services does not discriminate on the basis of race, color, national origin,
sex, religion, age or disability in employment or the provision of services.
350 copies of this public document were printed at a total cost of $ 1,295.03 or $ 3.70 per copy. 8/ 05
Table of Contents
Section I. Introduction ................................................................................................................. 1
Foreword....................................................................................................................... ......... 1
Vision Statement ..................................................................................................................... 1
Statutory Authority ................................................................................................................. 1
History ............................................................................................................................... .... 1
Section II. Developments in SCHS During Fiscal Year 2005 .................................................... 2
Background ............................................................................................................................. 2
Organization of SCHS ............................................................................................................ 2
Changes During Fiscal Year 2005 .......................................................................................... 2
Section III. SCHS Units ............................................................................................................... 7
Operations, Quality Control, and Administration Unit .................................................... 7
Description.................................................................................................................... . 7
Services ........................................................................................................................... 7
Accomplishments in FY 2004- 2005 ............................................................................... 7
Proposed Initiatives for FY 2005- 2006 .......................................................................... 9
N. C. Birth Defects Monitoring Program .......................................................................... 11
Description.................................................................................................................... 11
Services ......................................................................................................................... 11
Accomplishments in FY 2004- 2005 ............................................................................. 11
Proposed Initiatives for FY 2005- 2006 ........................................................................ 12
Central Cancer Registry .................................................................................................... 13
Description.................................................................................................................... 13
Services ......................................................................................................................... 13
Accomplishments in FY 2004- 2005 ............................................................................. 13
Proposed Initiatives in FY 2005- 2006 .......................................................................... 15
Health and Spatial Analysis Unit ...................................................................................... 16
Description.................................................................................................................... 16
Services ......................................................................................................................... 16
Accomplishments in FY 2004- 2005 ............................................................................. 16
Proposed Initiatives for FY 2005- 2006 ........................................................................ 17
Statistical Services Unit ...................................................................................................... 18
Description.................................................................................................................... 18
Services ......................................................................................................................... 18
Accomplishments in FY 2004- 2005 ............................................................................. 19
Proposed Initiatives for FY 2005- 2006 ........................................................................ 19
Section IV. Summary .................................................................................................................. 20
Fiscal Year 2005 Annual Report
State Center for Health Statistics i
SCHS FISCAL YEAR 2005 ANNUAL REPORT
Section I. Introduction
Foreword
The SCHS Fiscal Year 2005 Annual Report describes the work done in the State Center for
Health Statistics ( SCHS) during this past year and summarizes current and planned activities.
The report also presents the challenges that are expected to confront SCHS during the upcoming
fiscal year. SCHS operates in the Chronic Disease and Injury Section in the Division of Public
Health within the North Carolina Department of Health and Human Services.
Vision Statement
The State Center for Health Statistics, by providing high- quality information on the health of
North Carolinians, will positively influence decision- making and health policy, thereby
improving the health of all our citizens. By making better use of our human and technical
resources, we strive to provide health data to policy makers, researchers, and citizens as
efficiently and quickly as possible. Internally, the State Center seeks to create a better work
environment, resulting in both successful employees and satisfied customers.
Statutory Authority
The State Center is authorized by North Carolina General Statute under § § 130A- 371 to 130A-
376 to collect, maintain, and analyze health and health- related data and to explore new or
improved methods for obtaining data. The Center is also charged with managing the state’s
Central Cancer Registry ( CCR) as established by General Statute under § § 130A- 205 to 130A-
215, and the Birth Defects Monitoring Program ( BDMP) as established by General Statute under
§ § 130A- 131.16 to 130A- 131.24.
History
Created as the North Carolina Bureau of Vital Statistics by the State Legislature in 1913, the
Bureau evolved by 1980 into the State Center for Health Statistics. In 1980, Governor James B.
Hunt, Jr. directed the state health agencies ( then known as the Division of Health Services) to
administer the statistical activities mandated by the 1978 Public Law 95- 623. Under this Act, the
Division, through the State Center, was to coordinate all health data activity in the state and to
explore new ways of obtaining, analyzing, and disseminating health data. Since 1998, the State
Center has been part of the Division of Public Health in the N. C. Department of Health and
Human Services.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 1
Section II. Developments in SCHS During Fiscal Year 2005
Background
Prior to FY 2005, SCHS contained two additional units: Vital Records and Health Informatics.
Vital Records has now become a separate section. Health Informatics staff were assigned to three
separate agencies in DHHS, depending on their function and duties. Some were assigned to the
new Vital Records Section, others transferred to the Administrative Support Section, and some
were assigned to the newly created Office of Public Health Preparedness and Response in the
Epidemiology Section. Since March 2002, SCHS has operated under its new structure, which has
helped focus its mission of collecting, analyzing, and disseminating public health information.
On June 6, 2005, SCHS was organizationally moved from the Legal and Regulatory Affairs
Section into the Chronic Disease and Injury Section.
Organization of SCHS
The State Center is presently comprised of four programmatic units and one administrative unit.
• Birth Defects Monitoring Program ( BDMP)
• Central Cancer Registry ( CCR)
• Health and Spatial Analysis Unit ( HSAU)
• Statistical Services Unit ( SSU)
• Operations, Quality Control, and Administration Unit ( OPS)
Descriptions of these units are given in Section III.
Changes During Fiscal Year 2005
Budget and Personnel: As with many other state agencies, SCHS suffered a budget cut of
$ 10,000 from state appropriations during FY 2005. This was in addition to previous cuts during
the preceding two years. SCHS managed to continue operations without loss of positions but had
to curtail some operations funded from state appropriations. In order to manage these cuts and
maintain core functions, SCHS has continued to maximize the use of Federal Financial
Participation ( FFP) funds, grants, contracts, and receipts from the National Center for Health
Statistics ( NCHS) administered through the Vital Statistics Cooperative Program ( VSCP). The
State Center has also continued to enhance some categorical services such as the Central Cancer
Registry and Birth Defects Monitoring.
Notwithstanding the cuts, the SCHS experienced modest growth during FY 2005 by creating two
new positions funded through Centers for Disease Control and Prevention ( CDC) grants to
enhance work in the Central Cancer Registry ( CCR). At this time, these positions are being
classified and posted for recruitment, expected to be completed during FY 2006. The Birth
Defects Monitoring Program Unit ( BDMP), although not adding any new positions, expanded its
surveillance coverage to include all acute- care hospitals providing labor and delivery and/ or
pediatric services in North Carolina. In addition, through the Center for Birth Defects Research
and Prevention Project, the BDMP increased its collaboration with the University of North
Carolina at Chapel Hill ( UNC- CH) for research into the causes of birth defects.
Fiscal Year 2005 Annual Report
Page 2 State Center for Health Statistics
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 3
The State Center has at present 65 full- time equivalent positions ( FTEs). These positions are:
1 director
5 managers
5 administrative support staff
25 field staff or quality control staff
25 statisticians
4 applications programmers, computing consultants, or GIS specialists
Web Development: SCHS increased considerably the amount of information on its Web site
during FY 2005 to more than 22,000 pages and documents, doubling the number from the end of
FY 2004. Increasingly, the Web site has become a primary source for external and internal data
users. At the same time, the State Center maintains a schedule of regular publications and an
active distribution of printed special reports throughout the year. All regular and special
publications are now accessible on the web at the SCHS web site: http:// www. schs. state. nc. us/
SCHS/.
The increased use of the SCHS Web site by the public and other users is reflected in the
increased number of requests for pages and documents related to health statistics. Excluding
robots ( automated programs that gather web- based information), the number of requests in FY
2001 was 157,392; and the next year it increased 36 percent to 214,377. The number increased
even more ( 56%) in FY 2003 to 334,549. In FY 2004, there were 446,415 hits, an increase of 33
percent. During FY 2005, the number of non- robotic hits went up to 655,152, a further 47 percent
increase. In four years, use of the SCHS Web has more than quadrupled, a dramatic increase.
Figure 1 below graphically describes the trend.
Figure 1
Fiscal Year 2005 Annual Report
Page 4 State Center for Health Statistics
Furthermore, SCHS has increased Web support to other public health agencies by managing Web
sites for the Early Intervention Branch and for the office implementing the Health Insurance
Portability and Accountability Act ( HIPAA) in North Carolina. The State Center also continued
to manage the Office of Minority Health and Health Disparities Web site, maintain the Web sites
of the Epidemiology and Vital Records sections, and host the N. C. Healthy Schools site. In
addition, SCHS provides support for accessibility and online publications for the Division and
the Department.
SCHS has embarked on a project to make its Web site more accessible and responsive to the
needs of users. During FY 2005, we completed converting death files information into a
queryable system that now permits users to enter specific parameters for key variables and get
results quickly on- line. This is a key improvement over the previous passive system that allowed
for more limited information retrieval. SCHS has already started a similar project for the birth
data, which is expected to be completed during FY 2006.
Services to Users and Public: The SCHS’s core mission is the dissemination of health
information to administrators, policy makers, researchers, and the public at large. Although
information is distributed in printed form as well as on the Web, many of the services are
provided to people who call the SCHS main telephone line requesting health information.
Despite a reduction of the positions devoted to answering data requests, the SCHS has arranged
for this important function to be maintained with little decrease in timeliness or quality of
responses.
The simpler requests, requiring referencing an existing publication or the Web, can be answered
by support staff. However, most of the requests require more extensive search or programming.
These requests are submitted to the statisticians in the various units within SCHS. SCHS answers
the vast majority of these requests within a few hours or days at most. Only complex questions
requiring extensive SAS programming take longer than one week.
SCHS tracks the information services that it provides to others. Using that tracking system, we
know that there were at least 3,629 activities where health or demographic information was
provided to users from July 1, 2004 to June 30, 2005. This is an increase from last fiscal year of 3
percent and it reflects that, in spite of substantial improved access to information on the Web site,
many users continue to rely on staff to address their more complex data needs.
SCHS also handles many phone calls, related to programs or information, that are not recorded in
the activity reports. The number of phone calls handled during FY 2005 by SCHS over and
beyond those reflected in the activity reports was about 8,000.
Publications: SCHS produces a wide variety of publications. Many are part of the Center’s core
function of disseminating health information. Other publications are printed in collaboration with
other health agencies and focus on a particular issue of interest to that agency. SCHS also has a
system of special publications that reflect salient issues of public health interest. Occasionally,
SCHS will publish a Statistical Primer explaining a technical issue concerning statistics or
information processing. In addition, SCHS staff engage in extensive collaborations with
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 5
academicians and other health practitioners, sometimes resulting in joint authorship in a refereed
professional journal.
A title list of many of the publications done by SCHS can be found on the web site at:
http:// www. schs. state. nc. us/ SCHS/ pubs/ title. cfm.
During FY 2005, SCHS staff had sole or joint authorship on 8 journal publications and published
11 internal studies. Additionally, SCHS staff did over 50 presentations and posters during the
year; processed over 50,000 cancer records; investigated 30 cancer clusters in the state; and
conducted 4 special cancer projects. SCHS staff also reviewed over 9,000 records suspected of
having birth defects; engaged in 26 spatial analysis projects; and answered 14 special requests for
geographic analysis. SCHS published 19 special reports, ranging from data about health
disparities among America Indians and African Americans, to a comprehensive profile of health
status state- wide, and an updated booklet on cancer statistics.
Collaborative publications usually appear in the Web site under “ Journal Articles.” Many of these
collaborative publications are listed here under the individual units’ descriptions of activities
during FY 2005, found in Section III.
Collaborations: The four programmatic units in SCHS engage in extensive and varied
collaborations with agencies, ranging from those within the Division of Public Health to national
organizations and universities. Below are four examples of collaborations with other agencies
carried out by SCHS during FY 2005.
1. The Birth Defects Monitoring Program is in its third year as a collaborator, with the UNC
Department of Epidemiology, on the N. C. Center for Birth Defects Research and
Prevention. The Center’s goal is to identify the causes and means of preventing birth
defects. North Carolina is one of eight states being funded to participate in the CDC-funded
National Birth Defects Prevention Study, which is the largest ongoing case- control
study of birth defects in the world. Interviewing of cases and controls in North Carolina is
ongoing.
2. The Central Cancer Registry has been working with the Comprehensive Cancer Control
( CCC) program and the Advisory Committee for Cancer Coordination and Control to
evaluate the 2001- 2005 Cancer Control Plan and to develop the 2006- 2010 Cancer
Control Plan. The director of CCR attended national training with the CCC staff to best
utilize cancer registry data in planning and evaluation. The CCR has provided data for
both planning and evaluation, and the director serves on both the Care Subcommittee
workgroup and Steering Committee in development of the 2006- 2010 plan.
3. The Health and Spatial Analysis Unit continues to work closely with the HIV/ STD
Prevention and Care, Special Studies Unit on syphilis elimination. The North Carolina
Syphilis Elimination Project started in 1998. Since 1999, the Health and Spatial Analysis
Unit has created maps of new syphilis cases every quarter. These maps are used to
identify neighborhoods where rapid outbreak response, testing, counseling and health
Fiscal Year 2005 Annual Report
Page 6 State Center for Health Statistics
promotion might be needed. This targeted approach is leading to success – with a 71
percent decrease in early syphilis cases from 1998 through 2004 – and has led to further
collaboration on the spatial analysis of syphilis and HIV disease co- morbidity.
4. Staff of the Statistical Services Unit worked with the Division of Environmental Health
on a study of septic tank failure rates, comparing conventional ( gravel) systems with two
types of innovative septic tank systems. Staff of the Unit provided consultation to DEH
staff on the design of the sampling plan, sample size determination, data collection
instruments, and other study issues. The DEH is now in the process of collecting data in
the field. SSU staff will participate in the data analysis and interpretation phase after data
collection is completed.
A partial list of agencies with which SCHS collaborated on different projects during FY 2005 is
given below:
Women’s and Children Section, DPH
N. C. Chapters – March of Dimes
N. C. Child Fatality Task Force
UNC School of Public Health
Department of Maternal- Fetal Medicine, Wake Forest University School of Medicine
Division of Aging, DHHS
Division of Medical Assistance, DHHS
Office of Minority Health and Health Disparities, DHHS
Office of Research, Demonstrations, and Resource Development, DHHS
Epidemiology Section, DPH
Vital Records Section, DPH
Chronic Disease and Injury Section, DPH
Office of Healthy Carolinians, DPH
American Cancer Society
Indian Health Service
Local Health Departments
Cecil G. Sheps Center for Health Services Research
UNC Lineberger Cancer Center
Duke University Medical Center
Columbia University
UNC Carolina Mammography Registry
Battelle Center for Public Health Research and Evaluation
North Carolina Commission of Indian Affairs, Department of Administration
Breast and Cervical Cancer Control Program
Comprehensive Cancer Control Program
Division of Environmental Health, Department of Environment and Natural Resources
UNC School of Medicine, Center for Maternal and Infant Health
National Institute of Environmental Health Sciences ( NIEHS)
University of South Carolina Department of Ob/ Gyn- Genetics
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 7
Section III. SCHS Units
Operations, Quality Control, and Administration Unit
Description
The Operations, Quality Control, and Administrative Unit is responsible for the day- to- day
management of fiscal, personnel, training, and facilities/ repair functions within SCHS. This Unit
facilitates the operations of the programmatic units while also ensuring that SCHS complies with
all DHHS and DPH policies and requests. The Unit has responsibility for tracking and
monitoring purchases and payments, contracts, grants, and assets.
Services
• Implements SCHS, section, division, departmental, state and federal policies, procedures
and strategic plans with respect to budget, purchasing and spending, personnel, contracts,
MOUs, grants, and safety.
• Develops and oversees all SCHS state, receipt, Medicaid reimbursement, and federal
award budgets and activities, including accounts receivable and payable and contract
expenditures, and provides budgetary analysis and data to SCHS, section, division and
departmental managers.
• Prepares and monitors paperwork and revisions for all personnel and salary actions, and
tracks and reports on SCHS employee training activities.
• Plans for SCHS space, furniture and equipment needs, and arranges for office space
rentals, requisitions of equipment, and furniture purchases.
• Ensures all new SCHS employees receive SCHS Welcome Packet, including SCHS
orientation, SCHS SOP guidebook, and starter supplies.
Accomplishments in FY 2004- 2005
• Received approval for reallocation of Printing Phototypesetter II to Administrative
Assistant I and to award a salary increase effective April 1, 2005.
• Received approval to grant an IRA for position 25070 effective April 1, 2005.
• Received approval to grant an IRA for position 25009 effective October 1, 2005.
• Approved training for Administrative Secretary II to receive Notary Public certification
on behalf of SCHS.
• Arranged for Microsoft Word and Excel training and began onsite payables and
purchasing training sessions for DPH purchasing/ payables clerk.
• Conducted onsite training sessions for new Vital Records administrative employee.
• Completed updated Adobe PageMaker and In Design Training for Publications
Coordinator and backup.
• To foster rapid responses to SCHS budget, purchase and payment needs, refined
standardized procedures for communicating with budget, purchasing/ payables clerk
previously relocated to division office.
Fiscal Year 2005 Annual Report
Page 8 State Center for Health Statistics
• Refined standardized procedures for keeping SCHS central files updated and purged
according to state records retention schedules and the SCHS Director’s guidelines.
• Established personnel file folder checklist to ensure completeness of all personnel records
and forms.
• Reconciled and completed SCHS Timesheet audits biannually.
• Implemented weather event drills and began revising SCHS Safety Manual.
• Completed third draft of SCHS SOPs and appointed new SOP project coordinator.
• Developed SCHS Non- Disclosure Agreement form and revised SCHS New Employee
checklist.
• Completed standardized formatting and cataloguing of SCHS internal forms.
• Began working with SCHS webmaster to ensure upload to the SCHS Intranet of finalized
SOPs.
• Completed revision of publications mailing list, including preparing and mailing 650
update letters to external customers. Tracked and compiled their responses.
• Completed ServList email address update with SCHS webmaster.
• Created, revised, edited, arranged for printing and mail out of:
– 3 SCHS annual publications ( Pocket Guide, Volume 1, and Volume 2)
– 5 SCHS Studies
– 2 Minority Health fact sheets
– 1 SCHS Annual Report for FY 2004
– 1 Statistical Brief
– Health Profile of N. C.: 2005 Update
– N. C.’ s Plan to Prevent Youth Suicide ( report for Injury and Violence Prevention)
– 6 WIC Brochures ( English and Spanish)
– Converted TB Manual to pdf for web page and inserted 24 forms in the Revised TB
Manual
– Revised 46 forms ( WCH, Vital Records, and State Lab)
– Created 4 new forms ( 3 WCH, 1 Vital Records)
– Coordinated printing requests for Cancer Facts and Figures, BRFSS envelopes, and
PRAMS supplies ( surveys, brochures, calendars, Spanish index cards, fact sheets,
envelopes).
– Provided quality control and tracking services to the SCHS Survey Team for monthly
mailing of 3,000 pre- survey letters.
• Completed and instituted SCHS New Hire Protocol and implemented Welcome Packet
for new employees
• Served on the DPH Nutrition and Food Committee related to the Six Forks Move Project.
• Participated in various internal SCHS committees, including Data Disclosure Committee
and Special Events Committee ( chair).
• Cotton Building Roof Reconstruction Project November 2004 to January 2005:
– Represented Cotton Building on Pre- Bid and Bid Committees and negotiated terms of
temporary relocations with DOA State Construction, PC Lab, Vital Records, and
Epidemiology Sections.
– Coordinated with DOA and Epidemiology the relocation of cars parking in rental
spaces in close proximity with Cotton Building to state parking deck for duration of
construction project.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 9
– Coordinated with DPH IT and DPH Administrative Services Branch timetable and
logistics for temporary relocation of Cotton 2 personnel and their equipment.
– Implemented the temporary relocation of Cotton 2 personnel, including their
equipment and files to Cotton 1, Cooper 6 , Cooper 1 and Cooper 2 and their return to
Cotton 2.
• Began Cotton Building Beautification Project by completing repairs and painting to
Cotton 1 bathrooms ( including addition of new ceiling tiles, baseboards, and blinds),
foyer, and stairwell.
• Arranged for installation of snack machine for SCHS employees.
• Updated and reorganized SCHS mailroom, including selecting and installing new
accessories.
• Purchased, installed, and added caller I. D. function to new telephones for the CCR.
• Arranged for surplus of 296 items ( desktop computers, furniture, office equipment).
• Purchased approximately $ 140,000 in PCs ( 41), printers ( 8), servers ( 11), and software
( 13) for SCHS.
• For FY 2004- 2005, prepared and initiated authorized budgets for requirements and
revenue in approximately 18 cost centers in Fund 1160, totaling $ 4,751,440 including
$ 3,086,358 in salaries and fringes across multiple various revenue sources, including:
– $ 2,240,180 in state appropriations
– $ 590,690 in state receipts
– $ 133,801 in federal receipts
– $ 1,786,769 in federal grant or cooperative agreement awards
• Ensured that HIPAA and Workplace Harassment mandatory training completed by all
SCHS new staff and certification forms signed and turned in to DPH within specified
deadline.
• Ensured that all SCHS employees’ Work Plans contained provisions for:
– Mandatory training
– Customer service
– Activity report completion
– SCHS internal committee service
Proposed Initiatives for FY 2005- 2006
• Complete final draft of SCHS SOPs and upload to SCHS Intranet; keep updated.
• Begin pilot to ensure viability of SOPs.
• Publish main SOP directory, as well as a summary guidebook for all SCHS new
employees.
• Continue to refine SCHS New Employee Orientation Protocol.
• Get approval for reallocation of position 25052 to a classification more schematically
appropriate than its new Administrative Assistant I reallocation.
• Complete training of and transition work to division purchasing/ payables personnel.
• Maintain SCHS Central Files System and ensure adherence to the standardized
procedures for keeping files updated and purged according to state records retention
schedules and the SCHS Director’s guidelines.
• Organize and facilitate relocation of SCHS Survey Lab to new building.
• Complete Cotton Building repair and painting project.
Fiscal Year 2005 Annual Report
Page 10 State Center for Health Statistics
• Purchase new furniture for Cotton 1 and 2 bathrooms.
• Purchase, install, and add caller I. D. function to new telephones for SSU, BDMP, HSAU,
and Operations, as needed.
• Finalize CCR Unit personnel consolidation plan; coordinate and implement relocation of
personnel and equipment with other SCHS units.
• Request vendor quotations for new cubicles and new carpet for Cotton 2, and begin
paperwork to initiate purchases.
• Coordinate temporary relocation of SCHS personnel for possible staff relocation project
and coordinate purchase and installation of new cubicles and carpet at the same time.
• Ensure that all new employees complete HIPAA and Workplace Harassment mandatory
training, with certification forms signed and turned in to DPH within initial 90 days of
employment with SCHS.
• Ensure that all new SCHS employees’ Work Plans contain provisions for:
– Mandatory training
– Customer service
– Activity report completion
– SCHS internal committee service
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 11
N. C. Birth Defects Monitoring Program
Description
The North Carolina Birth Defects Monitoring Program ( BDMP) was formally established by the
N. C. General Assembly in 1995. The BDMP ascertains data on infants who are born with serious
congenital anomalies diagnosed within the first year of life ( approximately 4,000- 5,000 infants
per year). Data are collected by trained field staff who systematically review and abstract hospital
medical records, supplemented by information from administrative health databases such as
hospital discharge data, vital records, and other sources. This intensive method of case
ascertainment provides the most complete, accurate, and timely data on the incidence of birth
defects, thereby enhancing its usefulness to public health programs. The program maintains a
central registry with patient identifying information which is considered confidential under state
law. The BDMP works closely with other sections in public health, including genetics and the
Child Service Coordination Program, as well as with university- based researchers, advocacy
groups, and other stakeholders. In addition, the BDMP carries out data analyses for the North
Carolina Child Fatality Prevention Task Force and maternal mortality surveillance, and provides
other statistical support to programs within the Children and Youth Branch, Women’s and
Children’s Health Section.
Services
• Respond to inquiries from health departments, physicians, legislators, and the public
concerning the occurrence of birth defects in their communities.
• Provide data needed to help design, target, and evaluate public health prevention
activities.
• Conduct descriptive epidemiologic studies of risk factors for birth defects in North
Carolina, and collaborate with universities and others on etiologic studies of birth defects
in order to identify new avenues of prevention.
• Improve delivery of services to children with special needs through identification and
referral to appropriate services.
Accomplishments in FY 2004- 2005
• The BDMP has been collaborating with the UNC School of Public Health on the N. C.
Center for Birth Defects Research and Prevention. Efforts over the past year have led to
improvements in the quality and timeliness of National Birth Defects Prevention Study
( NBDPS) clinical data, including streamlining the process of initial data collection and
clinical review.
• As an extension of the above project, the BDMP has submitted a request to CDC for
supplemental funding to study the cost and utilization of services among children with
craniofacial anomalies who are on Medicaid. Preliminary work on this project is currently
under way, with funding expected to begin in September 2005.
Fiscal Year 2005 Annual Report
Page 12 State Center for Health Statistics
• The BDMP has implemented a new clinical database for its central registry, and is in the
process of deploying the database in the field in order to implement a fully electronic data
system. This new electronic database, which will be fully in place by August 2005, is
improving the efficiency of data collection for the program. The new system will enhance
the timeliness of case ascertainment and facilitate identification and referral of children
and families for services.
• Working with the UNC Center for Maternal and Infant Health, the BDMP has developed
a system for tracking the birth outcomes for women who received maternal serum
screening at UNC Hospitals. This system will help researchers evaluate the performance
of the prenatal screening program, and to assess possible adverse pregnancy outcomes
that may be predicted using prenatal serum markers.
• The BDMP has initiated a data exchange agreement with the Virginia Department of
Health to improve ascertainment of North Carolina resident infants who are treated out of
state.
Proposed Initiatives for FY 2005- 2006
• Continue participating in the National Birth Defects Prevention Study.
• In conjunction with the UNC Department of Epidemiology and other collaborators,
contribute to the development of a long- term research agenda for the North Carolina
Center for Birth Defects Research and Prevention.
• Collaborate with NIEHS and the University of South Carolina Division of Genetics on
the multistate Anencephaly Genetic and Environmental Links ( ANGEL) Study.
• Collaborate with the National Birth Defects Prevention Network on upcoming multistate
research projects.
• Update BDMP web pages to provide more current and complete data on birth defects
occurrence, risk factors, prevention, and services.
Central Cancer Registry
Description
The Central Cancer Registry ( CCR) collects, processes, and analyzes data on all cancer cases
diagnosed among North Carolina residents. All health care providers are required by law to
report cases to the CCR ( as in nearly all other states), but the primary data source is hospitals.
The CCR supplements hospital data with reports from physicians who diagnose cases that are not
seen in a hospital. Death certificates and pathology laboratory reports are used to help identify
cases that are missed in the routine reporting. Duplicate reports are consolidated in the data
editing process. This is primarily a cancer surveillance activity – monitoring the incidence of
cancer among the various populations of the state.
Services
The data are used by:
• State and county health departments to target resources for health education and screening
services.
• Researchers for investigations into the causes and treatment of cancers.
• Public health advocates for focusing attention on the risk of cancer.
• The CCR staff to educate the public and provide evaluations of geographic and
behavioral risk. Summary data are published on the Internet and in several periodic
publications.
• National organizations ( CDC and NAACCR) that pool the data for national estimates of
cancer incidence. These data submissions are also used to evaluate the quality and
completeness of the CCR data.
Accomplishments in FY 2004- 2005
• The CCR was certified by the North American Association of Central Cancer Registries
( NAACCR) as a high- quality registry for the fifth consecutive year.
• Completed migration of all data on an Access- based system to an Internet- based data
management system. The Web- based system has allowed staff to run more ad hoc quality
reports, and to provide instantaneous feedback to facilities submitting data, and its “ Town
Square” feature facilitated communication among staff and with reporting facilities.
• Filled a number of critical positions with highly qualified staff, including a field staff,
three statisticians, an office assistant, and a director.
• In collaboration with the American Cancer Society, published 2004 Cancer Facts and
Figures both in hardcopy and on the Web site. Published 2005 County Cancer Profiles on
the Web site; it will be printed by the American Cancer Society in June 2005.
• Produced the Cancer Collection and Reporting Manual for use by all facilities required to
report to the CCR.
• Implemented reporting from three freestanding radiation centers ( one of 15 are
remaining), three large urology practices, one dermatology practice, and two out- of- state
pathology labs.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 13
• Conducted an annual basic registrar workshop in Asheville, which was attended by 27
registrars. This training is nationally recognized, and attended by registrars from other
states, and the training materials developed by CCR staff are used by the National Cancer
Registrars Association. This year’s course material included the FORDS, treatment,
coding, quality control, TNM 6th edition and data collection of non- malignant Central
Nervous System tumors. The CCR also conducted three training workshops on non-malignant
Central Nervous System tumors and three workshops for non- registrars on
implementation of Collaborative Staging.
• Participated in the second NPCR linkage with the Indian Health Service to identify
American Indians in the CCR database. Also completed manual linkage with tribal rosters
for two tribes that are not served by the Indian Health Service.
• Hired temporary employees through the National Program of Cancer Registries grant to
help with Death Clearance, doubling the speed and efficiency of the process for 2003
cases.
• The CCR is a member of the North American Association of Central Cancer Registries
( NAACCR), seven staff members belong to the National Cancer Registrar’s Association
( NCRA), and 10 staff members belong to the Association of North Carolina Cancer
Registrars ( ANCCR). The CCR has five staff members who serve on committees or
taskforces of NAACCR or NCRA and three staff members who served on the board of
ANCCR. Three staff members serve on subcommittees of the Advisory Committee for
Cancer Coordination and Control and one member serves on its Steering Committee. The
CCR has been actively involved in developing North Carolina’s new five- year cancer
control plan.
• Completed update to study of cancer around asphalt operations in the state. Several other
large- scale cluster investigations are ongoing and in various levels of completion,
including pediatric leukemia in Forsyth and surrounding counties, brain cancer in New
Hanover County, and lung cancer in Wilkes and surrounding counties. The CCR
responded to over 30 cluster inquiries this year, many of them requiring more than
cursory analyses.
• Historically, the Veterans’ Administration hospitals have not reported cancer incidence.
However, during 2004- 2005 the CCR received a large amount of data from them.
• Every year at the time of the NAACCR submission, a number of last- minute edits are
made to the data, on a snapshot of the database. This year, those changes were
implemented using a database with a data entry interface, enabling staff to make changes
quickly, store the changes made, and track that these changes were made to the main
database after the NAACCR submission.
Fiscal Year 2005 Annual Report
Page 14 State Center for Health Statistics
Proposed Initiatives in FY 2005- 2006
• Develop a system for efficiently processing pathology lab data, incorporating the newly
identified cases into the CCR’s main database.
• Develop a system for incorporating all paper records into the electronic data system.
• Enhance the Web- based data management system with the following: development of
simpler data entry screens for small facilities, a module for rapid case ascertainment staff
to enter reports directly into the CCR database, and automated record updating.
• Fill open positions, including a statistical supervisor, one statistician, and one field staff,
and complete the establishment of two CDC- funded quality control ( QC) positions.
• Establish a more efficient process for resolving county and address inaccuracies,
including linkage with the Division of Motor Vehicles.
• Add a geographic analysis component to our data analysis capabilities to facilitate our
response to requests for cancer cluster investigations.
• Enhance our research activities by having a staff person devoted full time to research.
• Work with the Commission on Cancer’s Liaison Program to initiate reporting by medical
oncologists. One of the QC staff will do a casefinding study on a large oncology practice
in the Triangle area.
• Work with hospitals and physicians to improve reporting to 98 percent complete.
• Work with the Veterans’ Administration hospitals to improve regular reporting.
• Collaborate with researchers and other outside data sources to improve the quality and
completeness of the CCR’s data through data linkages.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 15
Health and Spatial Analysis Unit
Description
The Health and Spatial Analysis Unit uses Geographic Information Systems ( GIS) and other
software to describe and analyze the spatial and temporal relationships that exist among
mortality, morbidity, births, and population characteristics, along with the environment in which
they occur.
The Health and Spatial Analysis Unit also develops and maintains the SCHS Web site. In
addition, the Unit supports other sections in the Division of Public Health with their Web sites,
the use of GIS and spatial analysis.
Services
• Responds to map requests from state and local public health agencies, organizations,
universities, and the public.
• Supports SCHS research, publications and presentations by providing maps and other
spatial analyses.
• Provides spatial analysis expertise to other state, local agencies and programs on long-term
projects. Collaborations include Epidemiology Section: HIV/ STD Prevention and
Control Branch, Special Studies Unit; Women’s and Children’s Health Section: Nutrition
Services Unit and Early Intervention Unit.
• Provides GIS technical support to other DHHS Divisions.
• Manages the SCHS Web site and provides support in website development for other DPH
sections, the Office of Minority Health and Health Disparities, and the interdepartmental
N. C. Health Schools Web site.
Accomplishments in FY 2004- 2005
• Continued work with HIV/ STD on Syphilis Elimination Project ( SEP).
• Continued geocoding of 2003 Vital Records.
• Developed North Carolina Health Data Query System.
• Developed an implementation plan for an address geodatabase.
• Updated time series maps on the Web site.
• Continued support of the Family Day Care Homes ( FDCH) Project.
• Updated and maintained information on SCHS Intranet.
• Maintained and provided to users a GIS database of licensed medical facilities.
• Provided layouts of poster presentations for all SCHS Units.
• Produced and presented posters at ESRI International GIS Conference and N. C. State
Conference.
• Presented spatial analysis project on syphilis and HIV Disease at the N. C. State GIS
Conference.
• Provided staff to serve as a member of the North American Association of Central
Cancer Registries ( NAACCR) GIS Workgroup.
Fiscal Year 2005 Annual Report
Page 16 State Center for Health Statistics
• Provided staff to serve on the State Government GIS Users Committee ( SGUC); one
staff person chairs the committee and all staff are members.
• Provided staff to serve as a member of the Geographic Information Coordinating Coun-cil
( GICC), by appointment from the Secretary.
• Provided staff to serve as chair of the SCHS Presentation Committee.
• Provided staff to serve as a member of the N. C. GIS Conference Planning Committee.
Proposed Initiatives for FY 2005- 2006
• Upgrade software for and update content of the online Health Atlas.
• Become a participating member of N. C. OneMap.
• Execute the implementation plan for the address geodatabase.
• Expand the North Carolina Health Data Query System for births and birth defects data.
• Test the streamline geocoding processes.
• Conduct additional spatial analysis of syphilis and HIV disease.
• Implement a state agency license scheme for ESRI GIS software.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 17
Statistical Services Unit
Description
The Statistical Services Unit collects, analyzes, and disseminates data on the health status and
health care use of North Carolinians. Staff also measure the effects that health services and
programs have on the citizens of North Carolina. The Statistical Services Unit consists of three
main work teams:
Survey Operations: Operates the Behavioral Risk Factor Surveillance System ( BRFSS) and
Pregnancy Risk Assessment Monitoring System ( PRAMS) for North Carolina, two CDC- spon-sored
health surveys. Provides survey and data analysis support to state and local public health
programs in North Carolina. Designs, tests, and conducts special public health surveys.
Vital Statistics: Produces the annual vital statistics and induced abortion files for data analysis
and reporting, provides data for the national Vital Statistics Cooperative Program, and works
with the Vital Records Section on data quality improvement efforts.
Health Services Analysis: Analyzes and disseminates data related to Medicaid, Health Choice,
and hospital discharges. Staff work closely with the Division of Medical Assistance and the
Office of Research, Demonstrations, and Rural Health Development on issues of mutual interest
to these programs and the Division of Public Health.
Services
• Answer thousands of requests a year from all segments of North Carolina’s population.
• Maintain and link together various data sets enabling the SCHS to do comprehensive data
analysis and health research.
• Publish a number of special research and evaluation studies and about six annual publica-tions.
• Present educational and training sessions to public health professionals, university stu-dents,
and other groups on data use, analysis, and interpretation.
• Provide extensive data analyses and reports for state and local public health agencies.
• Carry out special analyses of the Health Services Information System ( HSIS), Medicaid,
Health Choice, and hospital discharge data files.
• Produce an annual online County Data Book as part of the North Carolina Community
Health Assessment Process.
• Provide statistical and other support to the Office of the Chief Medical Examiner and
analyze the medical examiner data to meet the needs of North Carolina public health
programs.
Fiscal Year 2005 Annual Report
Page 18 State Center for Health Statistics
Accomplishments in FY 2004- 2005
• Produced five major annual publications and eight special reports in addition to the ones
listed below.
• Published two Minority Health Fact Sheets, one for American Indians and one for African
Americans, in cooperation with the Office of Minority Health and Health Disparities.
• Published the Health Profile of North Carolinians: 2005 Update.
• Published the 2003 North Carolina Health Statistics Pocket Guide.
• Published, on the State Center for Health Statistics Web site, data tables for live births
broken out by receipt of Medicaid, WIC, health department prenatal care, Maternity Care
Coordination, and Child Service Coordination.
• Published, on the State Center for Health Statistics Web site, extensive county- level
graphs showing time trends in key health indicators.
• Established the Child Health Assessment and Monitoring Program ( CHAMP), a state-wide,
representative household telephone survey that collects data on children’s health
issues.
• Produced the Local Public Health Department Expenditures report for the chief of the
Administrative Support and Community Liaison Section.
• Produced extensive data for the Health Carolinians 2010 Midcourse Review.
• Published, on the State Center for Health Statistics Web site, extensive data tables based
on the BRFSS and PRAMS surveys.
• Enhanced quality control activities in the Vital Statistics Unit to improve the accuracy of
the birth, death, and other vital data for North Carolinians.
Proposed Initiatives for FY 2005- 2006
• Continue to provide technical support to the State Infant Mortality Collaborative ( SIMC),
both for the North Carolina “ home team” and for the national group.
• Publish focused- care study on children with special health care needs, in cooperation with
the Quality Management Unit of the N. C. Division of Medical Assistance.
• Participate in the evaluation of expanded Medicaid coverage of family planning services
( family planning “ waiver”), in cooperation with the Sheps Center for Health Services
Research, the Women and Children’s Health Section, and the Division of Medical Assis-tance.
• Provide technical assistance to the Occupational and Environmental Epidemiology
Branch to implement a study of the impact of water quality on the health of swimmers in
Falls Lake.
• Complete publication on estimates of the number of medically fragile children in North
Carolina and their health care costs.
• Continue to work with the Carolina Population Center on the North Carolina Birth Out-comes
Project and publish a SCHS Studies report on the effect of neighborhood contex-tual
factors on preterm births.
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 19
Section IV. Summary
During Fiscal Year 2005, SCHS moved to address changing needs in the area of health
information and dissemination. The old Geographic Analysis Unit ( GAU) was renamed Health
and Spatial Analysis Unit ( HSAU) to better reflect changes in its functions and to further
differentiate it from generic Information Technology functions. The differentiation was made to
clarify the roles of the unit as a result of a multi- year study carried out by the Department
examining all potential IT work within the Division of Public Health. Because the HSAU mainly
provides statistical and geographical analysis in support of health business functions, it is
important to maintain its identity as separate from traditional IT functions which are mainly
designated to provide technological support.
SCHS also continues to expand its research component in the areas of Birth Defects and Central
Cancer Registry. During FY 2005, a comprehensive and interactive database management system
was completed, allowing BDMP staff to dynamically enter field data from hospitals and have
access to the latest edited database. Both of those improvements permit quicker and more
accurate case abstracting work and should enrich the already expanded data base. This initiative
was part of the collaboration between the School of Public Health at UNC- Chapel Hill and the
BDMP at the SCHS and was made possible when UNC was awarded a CDC grant as a Center
for Excellence for Birth Defects Research in 2002, which facilitated investigations of birth
defects research questions. Cooperating with the N. C. State Laboratory of Public Health has also
expanded the available data from early screening tests that is used for the surveillance of newly
born infants with birth defects.
The Cancer Registry also saw the benefits of its Web- based case abstraction system which began
to bear fruit in increased accuracy and timeliness. This system, implemented in FY 2004, allows
field staff to enter data with greater accuracy and rapidity. CCR has also begun several
collaborative data- share agreements with investigators in several universities. Studies during FY
2006 should provide enhanced knowledge on key items of surveillance, prevention, early
detection, and treatment of cancer.
SCHS will continue to improve its Web site and postings, as that medium has become a central
piece in health data distribution and dissemination. SCHS has moved to increase health informa-tion
accessibility by posting all publications on its Web site and making the site easier to use.
Additionally, the SCHS initiated the creation of a queryable site that allows users much greater
flexibility in shaping inquiries into the death files. SCHS will continue to create dynamic data
systems on its Web sites during the coming year.
Once again, the SCHS experienced another significant growth in its BRFSS survey with in-creases
in the sample size and in the number of questions designed to address specific health
concerns from local and state agencies. Updated data from PRAMS was posted on the Web in a
more timely manner than in the past. Furthermore, a new survey designed to measure health risk
behaviors was started in January 2005. This system, called the Children’s Health Assessment
Monitoring Program ( CHAMP), promises to complement the information that the BRFSS al-ready
gathers for adults.
Fiscal Year 2005 Annual Report
Page 20 State Center for Health Statistics
Fiscal Year 2005 Annual Report
State Center for Health Statistics Page 21
During FY 2005, SCHS collaborated extensively with all sections of the Division of Public
Health, resulting in several publications. SCHS continued its policy of adjusting to reduced state
appropriations by increasingly relying on grants and receipts. This trend is likely to continue in
the foreseeable future. SCHS continues to answer thousands of inquiries each year from adminis-trators,
legislators, researchers, and citizens, and its accountability system for capturing work
activities has been improved.
The four programmatic units were productive during the year in addition to doing their mandated
and routine work; they also contributed to extensive data dissemination through regular and
special reports. The Operations, Quality Control, and Administration Unit, working closely with
the DPH Budget Office, was key in helping with the logistical complexities of having to relocate
all second floor staff to permit State Construction to put a new roof on the Cotton Building. This
dislocation of staff and work was effected as smoothly as possible thanks to the leadership of the
Operations, Quality Control, and Administration Unit and the flexibility of the staff who had to
be moved to alternative locations for several weeks. This Unit also continues to do an excellent
job in monitoring all components of operational support, including budget and personnel chal-lenges.
SCHS looks forward to engaging in future collaborations with health agencies, and will continue
to use its resources to serve the health information needs of the state in an efficient and effective
manner.
STATE OF NORTH CAROLINA
Department of Health and Human Services
State Center for Health Statistics
1908 Mail Service Center
Raleigh, NC 27699- 1908
MEDIA RATE